Weight For Length Index Research Articles

Association between Six Key Messages Behaviour and Incidence of Stunting in Under-Two-Year-Old Children in Central Java Province

Background: The stunting prevalence in Central Java Province remains high. Six key messages, i.e. iron tablet supplementation, healthy latrines, exclusive breastfeeding, Integrated Health Care Post (Posyandu) visit, hand washing, and Antenatal Care visit are the efforts to reduce the prevalence of stunting. Objectives: This study aimed to analyse the relationship between the behaviour of the six key messages and the stunting prevalence in four districts of Central Java Province. Methods: This cross-sectional study was conducted in Brebes Regency, Tegal Regency, Banyumas Regency, and Semarang City with 424 mothers who have under two-year-old children randomly selected as sample. Data were collected by interview using a structured questionnaire with the results grouped into attitude and practices categories. The body’s weight and length were measured by a digital scale and infantometer. Data were analysed using the chi-square test. Results: The findings indicated that 21.5% of children under two had stunting. Besides, behaviour regarding six key messages were mostly good. There was no association between mothers' iron tablet consumption behaviour and the nutritional status of under-two children. There was an association between maternal attitudes about exclusive breastfeeding and knowledge about hand washing with length for age index (p=0.004). There was also an association between antenatal care and Posyandu visits practice with weight for age index (p=0.004 and 0.018). There was a relationship between attitude regarding the use of latrines and the weight for length index (p=0.001). Conclusions: Only the key messages of exclusive breastfeeding attitude, antenatal care visit practice, Posyandu visit practice, and hand washing attitude were associated with the nutritional status of under-two children.

Socio-economic and environmental factors affecting the rehabilitation of children with severe malnutrition

Background Poor diet and high infection rates inflicted by lowsocio-economic status and poor environments among infants andyoung children appear to be major causes of severe malnutrition.Objective To determine the practical and likely effectiveness inrehabilitation of severe malnutrition.Methods A descriptive observational study was conducted on 27children at three different sites: (1) Five inpatients at the InpatientWard, Cipto Mangunkusumo Hospital, Jakarta (IP-CM); (2) 8 out-patients at the Metabolic and Nutrition Clinic, Cipto MangunkusumoHospital (OP-CM); (3) 14 outpatients at the Nutrition Clinic, Bogor(NC). All the patients followed were aged <60 months and suf-fered from severe malnutrition (weight for length index <-3 NCHSZ-score). Subjects were followed for 12 weeks. The IP-CM groupreceived standard treatment following the WHO recommendation,while the OP-CM and NC group received proper medical treat-ment and nutrition education for mothers. The OP-CM group un-derwent more extensive laboratory investigations.Results All children generally had low socio-economic status. Mostchildren experienced poor feeding, child care, and other healthpractices. A tendency of increased prevalence, number of episodes,and duration of infectious diseases was noted in the majority ofsubjects. However, an improvement of nutritional status was ob-served during treatment in all groups, particularly in the IP-CMgroup.Conclusion Socio-economic status and environmental factorsmust be considered in the management of severe malnutrition.Educating parents concerning proper feeding and child care prac-tices appears to be of permanent nutritional benefit for the chil-dren.

Nutritional status and common infections in infants in Burkina Faso: interest of an ‘overall morbidity score’

To study the overall impact of morbidity on the nutritional status of infants in a rural area of Burkina-Faso. A cohort of children (n = 114) were monitored from age 6 months to 2 years in 30 villages in north-eastern Burkina Faso. Anthropometric measurements and the incidence of illness were recorded at 6, 9, 12, 15, 18 and 24 months. An overall morbidity score was constructed including the duration of common illnesses and their effect on appetite. Mixed linear regression models were used to analyse the relation between this score and both the weight-for-length (WFL) and the length-for-age (LFA) index. After adjustment for potential confounders, the morbidity score at time T was strongly correlated with the WFL index at time T (P < 0.0001) and weakly correlated with the LFA index at time T + 1 (P = 0.06). When the morbidity score was divided into classes, at time T the mean WFL z-score for children with a high morbidity score was 0.34 z-scores lower than the one for healthy children (P < 0.0001); at time T + 1, the difference in the mean LFA z-scores between the same groups was 0.09 z-score (P = 0.02). However, similar results were obtained using simpler expressions of morbidity. Taken separately, diarrhoea or febrile illness had an effect on WFL (at time T), but only diarrhoea had an effect on LFA (at time T + 1). Morbidity was strongly correlated with weight loss in children in the short term and weakly correlated with a slowdown in growth.

Limitations of first-phase insulin response to evaluate insulin secretion in children.

The first-phase insulin response (FPIR) is a widely used method to evaluate beta-cell function during the prediabetic phase of evolving type 1 diabetes mellitus (DM). The aim of the present study was to evaluate the influence of clinical and methodological variables on FPIR in normal children and adolescents. Children and adolescents who were first-degree relatives of those with type 1 DM and healthy young adults were studied. All subjects were islet cell antibody-negative. A FPIR test was performed on all subjects while fasting. Insulin samples were drawn at 0, 1, 2, 3, 4, 5, 6, 8, and 10 min after 0.3 g/kg of dextrose. FPIR(1-10) was calculated as the area under the FPIR curve corrected for baseline. Eighty-five subjects aged 4-22 yr were studied, 43 of whom were pre-pubertal, 24 pubertal, and 18 post-pubertal. FPIR(1-10) values were lower in the pre-pubertal group when compared to either the pubertal and post-pubertal groups (415 [179-965, 2SD], 756 [256-2 223] and 684 [235-1 180] mU/L, respectively; p<0.05). Obese subjects had a higher FPIR than non-obese subjects (856 vs. 520 mU/L; p<0.005). Despite correcting for the influence of puberty and obesity, there remained considerable unaccounted variability in FPIR(1-10) (R=0.46). Further variables found to influence FPIR(1-10) were: fasting insulin level (r(2)=0.49); weight for length index (r(2)=0.38); peak blood glucose level (r(2)=0.38, all p<0.001); and pre-pubertal age (r(2)=0.20, p<0.05). FPIR exhibited wide inter-subject variability and was influenced by a number of clinical and methodological factors that make interpretation more difficult without more specifically defined standards.

Analysis of anthropometric growth trends and prevalence of abnormal body status in Tainan elementary-school children.

Objectives of this study were to examine the prevalence of over/underweight or obesity in Chinese children and investigate the trend of anthropometric change through the years. Cross-sectional measurements on randomly selected 6,373 Tainan elementary-school children were conducted in 1997. Anthropometric parameters such as height, weight, body mass index (BMI), triceps skinfold thickness (TSF), mid-arm circumference (MAC) and body-fat percentage (%FAT) were measured. Girls and boys had an average of 4.8 cm and 5.1 cm, or 3.7% and 3.9% increase in height, and 5.5 kg, 6.2 kg, or 19.9% and 22.2% increase in weight when compared to data of nationwide survey in 1986-88. If the height and weight were compared to the data of nationwide survey in 1993-1996, Tainan girls and boys would have similar height but have averaged 3.4% and 4.7% heavier weight. Mean BMI reached 19.4 kg/m2 for girls and 19.6 kg/m2 for boys of age 12 to 13. Mean %FAT of girls was 24.3% and of boys was 23.7%. When using weight-for-length index (WLI) larger than 1.2, mean weight exceeding 120% of age-and-sex specific mean weight, %FAT exceeding 30% to evaluate prevalence of obesity, results would be 42.1%, 17% and 22.0% respectively. In conclusion, both sexes had faster growth in weight than in height in recent 10 years. Boys had significantly higher weight, WLI, BMI, MAC than girls, while girls had significantly higher TSF and %FAT than boys. Prevalence of obesity is highly method-dependent. Appropriate index and cutoff values need to be developed.

Decreased insulin sensitivity in prepubertal girls with premature adrenarche and acanthosis nigricans.

Benign premature adrenarche (PA) is the term used to refer to girls with the early development of pubic hair before the age of 8 yr and is characterized by mild hyperandrogenism. Hyperandrogenism in adult women is often not as benign and has been associated with insulin resistance, acanthosis nigricans (AN), and the polycystic ovary syndrome. We have seen a group of young girls with PA who have also been found to have AN. The purpose of this study was to determine whether there are any clinical and biochemical differences in those girls with PA with and without AN. Twelve girls with PA were divided into two groups at the time of evaluation: group I, those without AN (n = 5); and group II, those with AN (n = 7). Adrenal androgen levels were determined in all subjects by a 60-min ACTH stimulation test. Insulin sensitivity was measured by the frequently sampled iv glucose tolerance test with tolbutamide and was assessed using the modified minimal model. Mean chronological age, bone age, and weight for length index were similar in the two groups. The baseline and stimulated levels of adrenal androgens were also not significantly different between the two groups. The group I girls (without AN) had an insulin sensitivity index of 6.75 +/- 1.31, which was in the normal prepubertal range. This was significantly different from that in group II (with AN), who had an insulin sensitivity index of 3.69 +/- 1.29. Therefore, many girls with premature adrenarche can have AN and decreased insulin sensitivity. Whether these girls have a truly benign course or are at risk of ovarian dysfunction or carbohydrate intolerance needs to be assessed.

The Modified Minimal Model: Application to Measurement of Insulin Sensitivity in Children*

The modified minimal model (MMM), a recently introduced method that assesses insulin sensitivity (SI) by a computed mathematical analysis of the relation between the change in insulin and glucose clearance after a bolus of iv glucose, followed 20 min later by a bolus of tolbutamide, has been standardized in adults, but this method has not been validated in children. We performed an abbreviated 90-min MMM test in 50 children who were siblings of patients with insulin-dependent diabetes mellitus and 7 healthy adult volunteers and compared the results to the standard 180-min MMM test in 11 of these subjects. The cohort consisted of 29 prepubertal children [16 males and 13 females; 8.7 +/- 2.0 (mean +/- SEM) yr old]; 16 pubertal children defined as less than 17 yr of age and Tanner stage 2-5 (8 males and 8 females; 13.4 +/- 1.8 yr old), and 12 postpubertal subjects (7 males and 5 females; 18.2 +/- 0.9 yr old), with no significant difference in the weight for length index (WLI) among the 3 groups and with sera of all subjects negative for islet cell antibodies and insulin autoantibodies. The test procedure consisted of 3 baseline blood samples over 30 min, followed at zero time by 0.3 g/kg 25% dextrose infused iv over 1 min and an iv injection of tolbutamide (5 mg/kg) 20 min later; sequential blood samples for glucose and insulin measurements were withdrawn from zero time until completion 90 or 180 min later. In the 11 subjects who underwent both the standard and the abbreviated tests, there was no significant difference between the SI estimated by the 2 methods provided that glucose and insulin values were interpolated at 180 min during the computer calculations of the abbreviated test. Using the 90-min abbreviated test, the SI of the pubertal subjects (2.92 +/- 0.45) was markedly less than that of the prepubertal subjects (6.57 +/- 0.45; P = 0.0001). While the postpubertal group value of 4.63 +/- 0.86 was significantly higher than that of the pubertal group (P = 0.0001), the pre- and postpubertal groups remained significantly different (P = 0.0001). The 10 obese subjects with WLI greater than 120% had a lower SI (3.5 +/- 0.53) than the 47 nonobese subjects with WLI less than 120% (SI = 5.48 +/- 0.42; P less than 0.04), and there was a negative correlation between SI and WLI. None of the study subjects experienced symptomatic hypoglycemia during the test.(ABSTRACT TRUNCATED AT 400 WORDS)

The prevalence of obesity and thinness in children from a lower socioeconomic population receiving comprehensive health care

The relative body weights of 1830 children from low-income families ranging in age from 2 months to 18 years were calculated using the weight-for-length index (WLI). The effects of age, sex and race on WLI were tested with a 3-way analysis of variance test. A significant age and race interaction was found for the whole sample, as well as significant age and sex interaction for blacks only. Additional analysis revealed that most of the variance in WLI could be explained by weight variations in black females. When the children were classified as obese, overweight, and thin basedon their WLI scores, black males were found to have the lowest prevalence of obesity followed by slightly higher values for the other groups. When overweight and obese children were combined into one group, black females had the highest prevalence of overweight-obese children followed by white males, black males, and white females. In contrast, white females had the highest prevalence of thinness, followed by white males, black females, and black males. Additional analysis suggested that there are important social and/or environmental factors within this particular socioeconomic group that are interacting with biological processes to influence the prevalence of obesity and thinness within each age group.